Provider Demographics
NPI:1568469963
Name:NAVINCOPA, STACEY A (RPH)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:A
Last Name:NAVINCOPA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:WEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:1442 W 90TH S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-9218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3512 VIA ESPERANZA WAY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8147
Practice Address - Country:US
Practice Address - Phone:801-505-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15263183500000X
UT6553967-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist